Atherectomy Surgery Procedure

Introduction

Atherectomy surgery is a minimally invasive vascular procedure used to remove atherosclerotic plaque from the inside of arteries. This buildup of plaque can restrict or block blood flow, often leading to conditions such as peripheral artery disease (PAD) or coronary artery disease (CAD). Unlike angioplasty, which compresses the plaque against the artery wall, atherectomy physically removes it using specialized tools inserted through a catheter. It offers a targeted approach to clearing arteries, making it especially useful in complex cases involving calcified or irregular plaque formations.

This atherectomy surgery procedure is particularly beneficial for patients who cannot undergo open surgery or where stenting and balloon angioplasty have proven inadequate. It can be performed in various parts of the vascular system, most commonly in the legs and sometimes in the coronary arteries. The following sections detail the key steps involved in performing an atherectomy surgery procedure and what patients can expect during and after the procedure.

Atherectomy Surgery Procedure

1. Preoperative Preparation and Evaluation :- Before undergoing atherectomy, a thorough evaluation is necessary to confirm the presence, location, and severity of arterial plaque. This typically involves diagnostic tests such as Doppler ultrasound, CT angiography, or conventional angiography. These imaging tools help the physician understand the extent of the blockage and determine if atherectomy is the most suitable treatment option. The patient’s overall health is also assessed to rule out contraindications. Blood tests may be performed, and the patient’s medications are reviewed. Those on blood thinners or with kidney conditions may need specific adjustments before the procedure. Patients are usually advised to fast for a few hours prior to the surgery and are given specific instructions on hydration, medication use, and transportation after discharge.

2. Anesthesia and Vascular Access :- Atherectomy is typically performed under local anesthesia with mild sedation. General anesthesia is rarely needed, as the procedure is minimally invasive and patients are usually awake but relaxed. Once the patient is prepped, the interventional radiologist or vascular surgeon will clean and numb the skin at the access site commonly the femoral artery in the groin or sometimes the radial artery in the wrist. Using imaging guidance such as fluoroscopy, a catheter sheath is inserted into the artery. Through this sheath, the surgeon will advance the atherectomy device to the site of the blockage. The entire process is visualized in real-time, allowing for accurate navigation of the instruments through the vascular system.

3. Advancing the Atherectomy Device to the Blocked Artery :- Once the catheter is in place, a guidewire is threaded through the artery and positioned across the area of plaque buildup. This guidewire acts as a track along which the atherectomy device will travel. The type of atherectomy device selected depends on the nature and location of the plaque. There are several types directional, rotational, orbital, and laser atherectomy each suited to specific clinical scenarios. The device is carefully advanced to the site of narrowing. Some devices use a cutting blade to shave off the plaque, while others use high-speed rotation or laser energy to vaporize it. The goal is to remove the obstruction without damaging the artery wall, thus restoring adequate blood flow.

4. Plaque Removal and Arterial Clearance :- Once positioned correctly, the atherectomy device is activated. In directional atherectomy, a blade cuts the plaque, which is collected in a chamber at the catheter tip. Rotational and orbital devices spin rapidly to sand down the plaque into microscopic particles, which are either removed by aspiration or allowed to flow downstream into small vessels where they are absorbed. In laser atherectomy, ultraviolet light pulses vaporize the plaque without generating heat, reducing the risk of thermal injury. Throughout the procedure, contrast dye may be injected intermittently to visualize progress and ensure effective plaque removal. Depending on the extent of the blockage, the surgeon may make several passes with the device to fully clear the artery. After adequate clearance is confirmed, the catheter is withdrawn.

5. Balloon Angioplasty or Stent Placement :- In many cases, atherectomy is performed as a preparatory step before balloon angioplasty or drug-coated balloon therapy. Removing plaque first makes it easier to dilate the artery and improve drug absorption into the vessel wall. If the artery remains unstable or prone to collapsing, a stent may be inserted to keep it open. The stent is expanded using a balloon and remains in place permanently to provide structural support. In other cases, where atherectomy alone provides sufficient clearance and vessel stability, no further intervention may be required.

6. Completion and Device Withdrawal :- After plaque removal and any additional procedures, the instruments are carefully withdrawn. The sheath is removed from the access site, and pressure is applied to stop bleeding. Sometimes, a closure device is used to seal the artery more securely. The patient is then moved to a recovery area for observation. Vital signs are monitored, and the access site is checked for bleeding or signs of complications. Most patients can go home the same day, especially if the procedure was uncomplicated and performed on a peripheral artery. Coronary procedures may require a longer hospital stay.

7. Recovery and Postoperative Care :- Recovery from atherectomy is generally quick, with minimal discomfort. Patients are advised to rest and avoid strenuous activity for a day or two. Some soreness or bruising at the access site is common, but serious side effects are rare. Medications such as anti platelets or blood thinners may be prescribed to reduce the risk of clot formation. Follow-up appointments are scheduled to monitor the success of the procedure and ensure long-term arterial patency. Lifestyle modifications, including smoking cessation, healthy diet, regular exercise, and blood pressure control, are strongly encouraged to prevent further plaque buildup. Patients may undergo imaging follow-up, such as duplex ultrasound, to assess blood flow and detect early signs of restenosis. In the case of PAD, improved walking ability and healing of leg ulcers are positive signs of procedural success.

Conclusion

Atherectomy surgery is a vital tool in the treatment of arterial blockages, offering a minimally invasive yet highly effective method for restoring blood flow. Its versatility allows for treatment of complex and calcified plaques, especially in patients for whom traditional stenting or angioplasty may not be suitable. The procedure involves careful imaging, device navigation, targeted plaque removal, and sometimes additional interventions such as stenting or balloon dilation. With proper postoperative care and lifestyle changes, patients can experience significant relief from symptoms and a reduced risk of future vascular events.